Report (14) •
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FIRE SAFETY SYSTEMS
AQUASAFETm FLOW TEST
VERIFICATION
aIIIIIIIIIIIIIII
AquaSAFE' Flow Test Verification Form
Alliance
Member ID:
Important Installing contractor must submit this
_____._ completed form.Failure to do so nullifies the
Company Name: �' ctt L '. system warranty.Email or fax completed form
n � — to the Uponor Fire Safety Design
Contact: _K � at technicaa.servic�u Department
Ponor.com or 952.997.1731.
Phone" =4(�ja- �(a For questions,contact Uponor Technical Services at
—— 888.594.7726 or tnehniral_ur.i..m.._-------
Fax: c /�
,{� _Q(h,p Color of test orifice used:
Job Name: IC 1 Vel' Static pressure(not flowing)reading at incoming
Project Number: _ � water supply into home or at main shutoff:
�'IJ PP Y ��_
Job Address: ��p 54) �
City: `'Pa�/�,�� Residual pressure(flowing)reading at incoming water
�� supply into home or at main shutoff:
State,ZIP: Oft c'j
• For designs not provided by Uponor, complete the What time of day was the flow test taken? !r
following information. Flow test method used? *Bucket J Flow Meter
Designer's Name: i .eFlow test gpm:_J
Company: _(�p� �y t'' _— _ How many gallons of water did the design predict
Phone: , 9-5-----1- --0----
,1 0 — as requird? /�
Did the test meet or exceed design flow? Yes No
Fax:
Which sprinkler did you flow?Number: 1(1
Is the warning sign permanently attached close to the
main shutoff valve? L.1 Yes No Location of head: Lc1
Yes No Date left in service with all valves bpen: /Ilia_
12
Was this system required by code?
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Test Witnessed and Verified by:
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N _ i��q e Si at r Occupation Date
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2 Additional
o Explanations and Notes
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a. Uponor,Inc Tel:800.321.4739
5925 148th Street West Fax:952.997.1731
Apple Valley,MN 55124 USA . Web:www.uponor-usa.com